China needs comprehensive public health intervention to control syphilis epidemic

Thursday, May 6, 2010 — Syphilis is currently at epidemic proportions in China and rates of infection will continue to grow unless a more comprehensive, coordinated effort of control is implemented, according to an editorial by UNC's Dr. Joseph D. Tucker.

CHAPEL HILL — Despite the virtual elimination of syphilis in China in the 1950s, the sexually transmitted infection is currently at epidemic proportions in the country and rates of infection will continue to grow unless a more comprehensive, coordinated effort of control is implemented, according to a perspective published in the May 6 issue of the New England Journal of Medicine.

Syphilis in China is growing at a rate faster than any other country since the introduction of penicillin. Today, one baby is born every hour with congenital syphilis, which can cause serious and irreversible birth defects.

China's rapid economic growth has produced some unpleasant consequences, including a large commercial sex industry fueled by many businessmen with money and young women without it. “Social changes have spawned a massive resurgence of syphilis,” said Joseph D. Tucker, M.D., a fellow at the University of North Carolina at Chapel Hill School of Medicine and Massachusetts General Hospital.

The economic growth combined with mass urbanization means that Chinese society is experiencing more dramatic change than other developing countries. The authors of the paper argue that in dealing with the syphilis epidemic, the Chinese government and public officials must take into account the depth of China's social change and the social stigma associated with the high-risk behaviors associated with syphilis.

With public officials under immense pressure to address the syphilis problem, they have resorted to targeting--and often detaining--commercial sex workers. "The traditional approach of focusing on individual behaviors is not working," said Tucker, who received his medical degree from UNC.

Stigma surrounding sexually transmitted infections is not unique to China, but Chinese social structures place an extraordinarily high value on public dignity and socially acceptable behaviors. "High-risk sexual behavior is more highly stigmatized in China than in other places," Tucker said.

He and his colleagues call on China to recognize sexually transmitted infections as an urgent public health problem. "We need an integrated, interdisciplinary treatment and prevention strategy, "Tucker said, "if China is going to eliminate STIs once again."

Co-authors include Xiang-Sheng Chen, M.D., Ph.D., National Center for STD Control and Peking Union Medical College, and Rosanna W. Peeling, Ph.D., London School of Hygiene and Tropical Medicine.